Computer tomography (CT)-guided percutaneous core biopsies are currently the gold standard in diagnostic procedures for patients with bone lesions of unknown kind. CT-guided biopsies can lead to misdiagnosis or repetition of biopsies in case of small or heterogeneous lesions. We hypothesize that molecular image guidance could be used to optimize the biopsy strategy, by supporting the detection of heterogeneous lesions or lesions without radiographic substrate. To evaluate this hypothesis, we investigated if and how the addition of 2-deoxy-2-18F-fluoro-D-glucose-positron emission tomography (18F-FDG-PET)/CT could augment routine CT-guided bone biopsies. To this end, 106 patients who underwent a CT-guided bone biopsy between April 2019 and April 2020, obtained from either a vertebral or peripheral bone, were included. Patients were divided into 2 groups: 36 patients received an18F-FDG-PET/CT scan prior to their CT-guided bone biopsy (PET group), while 70 patients only had a morphological CT scan (CT group). Histopathology was used to categorize biopsies into five subgroups (inconclusive, benign, malignant or infectious disease, or normal tissue). In the PET group, the number of conclusive biopsies was significantly higher compared to the CT group (N = 33/36 (92%) versus N = 53/70 (76%);p< 0.05). Furthermore, the number of first-try biopsies was lower in the PET group compared to the CT group (1.9 vs. 2.54,p= 0.051). In conclusion,18F-FDG-PET/CT imaging significantly increased the success rate of first-try CT-guided bone biopsies by showing less inconclusive biopsies and misdiagnosis.
计算机断层扫描（CT）引导下经皮穿刺核心活检是目前诊断不明性质骨病变患者的金标准。对于体积较小或异质性病变，CT引导活检可能导致误诊或需重复活检。我们假设分子影像引导可通过辅助检测异质性病变或无影像学基质的病变，从而优化活检策略。为验证这一假设，本研究探讨了联合使用2-脱氧-2-18F-氟代-D-葡萄糖正电子发射断层扫描（18F-FDG-PET）/CT能否增强常规CT引导骨活检的效果。研究纳入2019年4月至2020年4月期间接受CT引导骨活检的106例患者（取材部位包括椎骨或外周骨），将患者分为两组：36例患者在CT引导骨活检前接受18F-FDG-PET/CT扫描（PET组），70例患者仅接受形态学CT扫描（CT组）。通过组织病理学将活检结果分为五个亚组（不确定结果、良性病变、恶性病变、感染性疾病或正常组织）。PET组的明确诊断活检数量显著高于CT组（33/36例（92%）对比53/70例（76%）；p<0.05）。此外，PET组的首次尝试活检次数低于CT组（1.9次对比2.54次，p=0.051）。综上所述，18F-FDG-PET/CT影像技术通过减少不确定结果和误诊，显著提高了CT引导骨活检首次尝试的成功率。
Augmenting CT-Guided Bone Biopsies Using18F-FDG PET/CT Guidance
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